Patients with schizophrenia activate behavioural intentions facilitated by counterfactual reasoning

Abstract

Previous research has associated schizophrenia with an inability to activate behavioural intentions facilitated by counterfactual thinking (CFT) as a step to improving performance. Consequently, these findings suggest that rehabilitation strategies will be entirely ineffective. To extend previous research, we evaluated the influence of CFT in the activation of behavioural intentions using a novel sequential priming paradigm in the largest sample of subjects explored to date.MethodThe main variables assessed were: answer to complete a target task (wrong or correctly), and percentage gain in the reaction time (RT) to complete a target task correctly depending on whether the prime was a counterfactual or a neutral-control cue. These variables were assessed in 37 patients with schizophrenia and 37 healthy controls. Potential associations with clinical status and socio-demographic characteristics were also explored.ResultsWhen a counterfactual prime was presented, the probability of giving an incorrect answer was lower for the entire sample than when a neutral prime was presented (OR 0.58; CI 95% 0.42 to 0.79), but the schizophrenia patients showed a higher probability than the controls of giving an incorrect answer (OR 3.89; CI 95% 2.0 to 7.6). Both the schizophrenia patients and the controls showed a similar percentage gain in RT to a correct answer of 8%.ConclusionsChallenging the results of previous research, our findings suggest a normal activation of behavioural intentions facilitated by CFT in schizophrenia. Nevertheless, the patients showed more difficulty than the controls with the task, adding support to the concept of CFT as a potential new target for consideration in future therapeutic approaches for this illness.

Counterfactual thinking in psychiatric and neurological diseases: A scoping review

“…Finally, two studies (7%) probed the “causal order effect” [ 41 ], meaning the tendency to choose the first event of a sequence as the most decisive for the final negative outcome [ 9 , 28 ]. Finally, two studies (7%) investigated the influence of CFT on the automatic activation of behavioral intentions using the sequential priming paradigm [ 10 , 30 ].…”

“…Overall, 21 out of 29 studies (72%) focused on psychiatric diseases whereas only eight studies (28%) considered neurological conditions. More specifically, six works focused on schizophrenia [ 9 , 10 , 12 , 22 , 28 , 30 ], five probed CFT in the presence of depressive symptoms [ 13 , 23 , 26 , 27 , 32 ] and five investigated the relationship between CFT and post-traumatic distress [ 25 , 32 – 34 , 42 ]. Three studies addressed the relationship between CFT and anxiety traits [ 32 , 35 – 37 ].…”

“…The generation of counterfactual thoughts related to a negative real-life [ 14 – 16 , 22 – 27 ] or a fictional event [ 9 , 23 , 25 , 28 , 29 ] and the CIT [ 12 , 14 – 16 , 22 , 24 , 28 – 31 ] were the most popular tasks adopted, followed by the Counterfactual Thinking for Negative Events Scale [ 32 , 33 ] or similar questionnaires [ 34 – 37 ] and the counterfactual gambling task [ 11 , 12 , 31 , 39 ]. Only a minority of studies investigated the influence of anticipated counterfactual regret on behavior [ 15 , 24 ], the “causal order effect” [ 9 , 28 ], and the influence of CFT on the automatic activation of behavioral intentions using the sequential priming paradigm [ 10 , 30 ].…”